Guidelines for Bereavement Counselors

This information is intended for bereavement counselors as they reach out and support our families.

Initial Steps

When you first contact the family, be aware that it may take a few tries, as they are most likely in a state of shock and disbelief. While speaking with the family, be mindful to recognize that the infant is unique and irreplaceable. Don’t rationalize the loss with comments such as, “You can have other babies” or “You have other children”. Do say – “ I’m sorry”, This must be so hard” or “How can I help?”

Reassure the parents that their expression of grief and the intense feelings associated with it are normal.

Be real; Share feelings of sadness with the parents. This is not an unprofessional behavior. Parents greatly appreciate caring physicians, nurses or health care workers who express their feelings.

Let parents know that they can take their time. There will be many decisions to make, but nothing needs to be decided immediately. Families need to be comfortable with the decisions they make.

Encourage the parents to name their baby (for stillbirth and miscarriage) and use the name when referring to the child. A name provides an identity, a means of talking about this little person and can help facilitate the grieving process. If the family chooses not to name their baby, be careful to always refer to the child by the appropriate sex.

Information

The parents will probably have a lot of questions. Be approachable and accessible to them. Grieving parents may need to ask the same questions over and over again before they are able to fully understand what has happened. Be patient and realize that most of the parent’s energy is directed toward coping and they may be functioning at a minimal level.

Some parents may not know what to ask, or what information may be helpful to them in the days and weeks ahead. Your experience and expertise will be invaluable. Consider sharing some of the choices other parents have made. Most importantly, assure the family that you will be available to answer any questions that may come up.

Interventions

Keep in mind that the following support skills are incredibly helpful for assisting our families: empathy, acceptance, listening, and fostering strengths.

Encourage families to maximize existing networks of support including extended family, friends, colleagues, neighbors and religious communities. Bereavement counselors may assist in facilitating effective communication among families members including difficult discussion of logistics (funeral costs and plans, removal of infant furniture, etc.)

If you begin to observe risk factors appear or exacerbate (smoking, alcohol, illicit drug use, excessive weight gain/loss) provide the family with support and resources.

Talking About the Grief Process

Give parents anticipatory guidance regarding what they might experience during the period of acute grief: somatic complaints, feeling of unreality, loneliness, depression, guilt, anger, irritability, loss of routine patterns, preoccupation with the child that died, insomnia and difficulty with friends and family. Tell them there may be differences in the style and length of grieving between the mother and the father.

Parents don’t forget, but as time passes the pain lessens. Educate parents about sudden and dramatic emotional shifts. Educate them that even when life seems to be back to normal, there may still be some unexpected and painful reminders such as anniversary dates and some holidays. Being retriggered is part of the normal grief process. It’s not unusual for parents to continue to experience occasional moments or days of sadness throughout their lives.

Referrals

Bereavement counselors should encourage a funeral and burial for the child. Offer the parents telephone numbers of mortuaries close to their home. Encourage both parents to be involved in this decision making process. This will be the last thing, as parents, they will ever be able to do for their child.

Provide the names and numbers of support groups for parents who have experienced the death of a child. It may be very difficult for parents to reach out for support at this time. Offer to make the first call for them.

Follow-Up Contact

It is important to recognize the needs and wishes of each individual family in regards to follow up contact. Please contact the families at the time of death and again two to three days later. Many families report that they are "in a fog" for several weeks so it is important to be aware of this continue to reach out.

One to four months after the death of the child is a critical period. Support has dropped off, the initial shock is gone and the reality of the child's death begins to set in. Families may need increased support during this time.

Please follow up with families on the one year anniversary of the child's death. This may be a good time to discuss memorials and ways to commemorate the child (see below).

As always, it is important to support families as needed. Grief processes and timelines vary and every individual will have unique needs.

Cultural Considerations

Be sensitive to language barriers. Many parents have left the hospital not fully understanding the cause and/or contributing factors to their child’s death. Try to share any information you can in a manner that will be easy for them to understand. If parents are monolingual in another language, or if English is their second language, every effort should be made to use a translator fluent in both languages, with the appropriate medical background. In crisis situations, family members should not be asked to translate for one another.

Not all cultures express grief or respond to death in the same manner. Click here to learn more about cultural difference and grief.

Mementos

Many hospitals offer mementos for families including pictures, the blanket that wrapped their baby, a lock of hair, handprints/footprints, hospital wrist band and name card. The family may also want to develop a memory box for siblings.

Memorials

Birthdays, holidays, anniversary of the loss and special occasions may be particularly difficult for grieving families. It may be helpful to acknowledge this with families and to be aware of upcoming dates. You may want to suggest some of the following gestures of commemoration for these days:

Lighting a candle

Attending religious service

Give a donation or gift to a special charity

Plant a tree

Balloon Release

Additional Resources

The majority of the content on this page comes from Maher H., When the Bough Breaks: Working with families who have experienced the death of an infant. A program of Tiburcio Vasquez Health Center, Inc.(510) 571-5907. Material used with permission.